Secondary Infertility

Causes, Costs and Treatments

By Suzanne Koup-Larsen

Most people assume that couples who already have a child can easily have another, says Pamela Kelberg, MSSW, LCSW, a therapist specializing in infertility coping, who practices in Philadelphia and Bala Cynwyd, PA, but reality often differs.

When women with children have difficulty having more children, it is called secondary infertility. Overall, infertility affects 10%-20% of the population, says Ronald F. Feinberg, MD, PhD, and director of IVF programs with Reproductive Associates of Delaware in Newark. Approximately 35%-40% of those patients already have children.

Sarah Cochran (a pseudonym) of Philadelphia is a mom in her early 30s. Despite trying for a second baby for more than two-and-a-half years, she and her husband have not yet had success. “We still feel like our family is not complete,” she says.

Possible causes

Secondary infertility shares many causes with primary infertility, says Dr. Feinberg. However, some factors can differ the second time around. For example, scar tissue from a previous C-section may interfere with conception.

Also, a woman’s fertility decreases as she ages. For women under 35, experts recommend trying for a year to get pregnant before seeking fertility help. However, they say women over 35 should not wait longer than six months.

The father’s fertility plays a role in secondary infertility, too. If he had a borderline low sperm count prior to an earlier pregnancy and his count drops further, it can be harder to conceive.

With medical intervention, “A lot of the problems that occur with aging are correctable,” says Jerome H. Check, MD, PhD, of the Cooper Institute for Reproductive Hormonal Disorders in Mt. Laurel, NJ.

Treatments

In vitro fertilization treatments have changed in the last decade. During IVF, a doctor fertilizes a woman’s egg with her partner’s sperm and then transfers the embryo to the uterus. The process is much more scientifically based and more cost effective than in the past, Dr. Feinberg says. “Your opportunity to be successful is so much higher than before,” he notes.

Other options to boost pregnancy chances include oral or injectable medications and intrauterine insemination. A woman can take an ovulation drug like Clomid to promote the release of eggs. Progesterone can help the uterine lining support embryo implantation. IUI, during which a doctor injects sperm directly into the uterus, can improve conception rates in cases of low sperm count.

“We try to do things that are not risky and not expensive if possible,” says Dr. Check. “We give people choices about what treatments they want to try and how much to spend,” he adds.

Costs

Many insurance plans will cover an infertility diagnosis, says Dr. Check, but many do not cover treatment. Insurance does not typically cover IVF, but New Jersey is one of 15 states that mandates insurance coverage for infertility treatments.

“It doesn’t cost much to do a consultation with a reproductive specialist,” says Dr. Feinberg, and most of them will review a patient’s history and assess their insurance coverage.

Impact on family life

“It’s really like having a full-time job on top of being a parent, which is a full-time job,” says Kelberg of pursuing fertility treatments. “The energy and focus devoted to the treatments, not to mention the financial resources involved” can cause stress, she adds.

Talking with a friend, family member or therapist, or in a support group, can help, recommends Kelberg. “No one understands the complexity of infertility like those who have been through it themselves,” confirms Sarah.